A gastronomic delight?

Abstract

Lichen nitidus typically presents as shiny pin-head sFlagellate dermatitis (FD) exhibits a striking clinical appearance similar to whiplash marks. General dermatologists are likely to encounter this clinical appearance as a more localized presentation of phytophotodermatosis. Jellyfish stings may also cause localized linear or FD. Chemotherapeutic agents such as bleomycin, doxorubicin, docetaxel, and trastuzumab are well-recognized causes of a widespread FD and it may more rarely be seen in connective tissue disease such as dermatomyositis or Still disease. In our case, this was a presentation of shiitake mushroom dermatitis. The eruption of shiitake mushroom dermatitis occurs within hours to 7 days after eating the raw or lightly-cooked mushroom; it resolves spontaneously within 1 to 3 weeks without hyperpigmentation. In terms of management, topical steroids, emollients, oral antihistamines, and psoralen ultraviolet A phototherapy may be helpful for symptomatic relief. Re-ingestion of shitake mushrooms is believed to be safe if they are thoroughly cooked at a temperature over 145C to allow denaturation of the toxin. We share this case to remind clinicians of the striking features of shiitake dermatosis, to facilitate an immediate diagnosis, appropriate management, and reassurance for presenting patients.